Measuring Hospital Care By the Decibel
Patient Safety Excessive false- or non-actionable signals can desensitize clinicians to important alarms, setting them up to miss critical responsibilities and putting patients at risk.
Health care technology is sending an alarm signal, alerting the nurse that a patient’s condition is deteriorating. All is working as planned—if the patient truly requires clinical intervention.
Unfortunately, hundreds of thousands of unnecessary beeps sound each day in hospitals when the patient does not require clinical help. These “non-actionable alarms” are not merely an annoyance; they are dangerous. Humans cannot attend to these numerous, competing signals.
Thousands of alarm-related patient injuries and deaths have been reported. Over a recent four-year period, the Food and Drug Administration (FDA) received more than 500 reports of patient deaths related to alarm systems on monitoring devices (i.e. physiological monitors, ventilators, infusion pumps and many others).
"Clinically actionable alarm signals are drowned out by a cacophony of non-actionable alarm signals."
Clinicians face a daunting array of challenges. These thousands of non-actionable alarm signals can be perceived as background noises that compete with environmental noise and patient care responsibilities for clinicians’ attention. True, clinically actionable alarm signals are drowned out by a cacophony of non-actionable alarm signals. It is a difficult, complex problem.
Managing this challenge must be a shared activity that encompasses every aspect of patient safety—people, technology, the environment of care and the organizational culture—as well as systems thinking and improved, intuitive device-interface designs.
Some hospitals are making vast strides to improve alarm management, resulting in a safer environment for patients and clinicians who are better equipped to make faster, more efficient clinical decisions. Unfortunately, many of the nation’s 5,000 hospitals are struggling to meet the critically important 2014 and 2016 National Patient Safety Goals to improve alarm management put forth by The Joint Commission (accredits over 19,000 health care organizations).
The bottom line is that many hospitals need help in getting there. All patients and all clinicians deserve to be in an environment that promotes optimum healing and excellent patient outcomes.